MEDICARE: RELIABLE MEDICAL SUPPLY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		GA

General Provider Information

NPI Number	:	1215394457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIABLE MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	6703 SHANNON PKWY
Second Line	:	SUITE 9
City	:	UNION CITY
State	:	GA
Zip	:	30291-2073
Country	:	US
Telephone Number	:	404-432-5678
Fax Number	:

Provider Business Practice Location Address
First Line	:	6703 SHANNON PKWY
Second Line	:	SUITE 9
City	:	UNION CITY
State	:	GA
Zip	:	30291-2073
Country	:	US
Telephone Number	:	404-432-5678
Fax Number	:

Authorized Official
Title or Position	:	PRESIDEN/CEO
Name	:	DR. HAZEL L SEAY
Credential	:
Telephone Number	:	404-432-5678

Provider Enumeration Date	:	01/19/2016
Last Update Date	:	01/19/2016

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